Whole Body Vibration Therapy Contraindications

A number of recent studies have looked into whole body vibration therapy contraindications and the effects of whole body therapy platforms on the health of bones.

Bone is living tissue that responds well to a mechanical stimulus such as movement.

This technical article on whole body vibration therapy has been prepared for health professionals (Physiotherapists, Physical Therapists, etc) who treat clients with osteoporosis, osteopenia and low bone density.

Any health professional considering purchasing a whole body vibration platform for their clinic or recommending a whole body platform to their clients should read the following excellent review, Whole-body vibration as potential intervention for people with low bone mineral density and osteoporosis. The reference is cited below. (1)

Theories on How Whole Body Vibration Affects Bone

• Like physical activity, Whole Body Vibration activates receptors in bone and stimulates bone building. This theory proposes that movement of the vibration plate generates a “tonic vibration reflex,” similar to the stretch reflex. The tonic vibration reflex has been reported to be activated continuously during Whole Body Vibration so that the muscles continue to contract and relax until the stimulus stops (1, 2). Consequently, bone may respond to the applied forces generated during muscle contractions from a tonic vibration reflex.
• Whole Body Vibration may also influence bone building indirectly via a hormonal response. Whole Body Vibration has been shown to acutely alter testosterone and growth hormone levels (3, 4).  The combination of a mechanical load and Whole Body Vibration exposure may stimulate larger increases in growth hormone than mechanical load alone.

The Six Variables

The six variables of a vibration platform that affect your bones are:

• Direction of the vibration
• Frequency vibration (in hertz),
• Magnitude vibration measured as amplitude. Amplitude describes how much motion exists in each direction (in millimeters).  Magnitude of a vibration stimulus is a combination of amplitude and acceleration.
• Acceleration describes how quickly the motion exists in each direction (in gravitational units, where 1.0 g = 9.81 m/s²),
• Time on the platform
• Body position/posture on the platform.

Standing straight will enhance the ability of the vibration to move up the legs through the hip and spine, whereas a relaxed stance (i.e., bent knees) will decrease the ability of the vibration to move past the hips. (5).

Direction of the Vibration

A number of different WBV platforms are commercially available (6-10), and they provide a vibratory stimulus in one of two ways:

• Vertical displacements.  On such platforms the entire platform moves uniformly.
• Oscillatory alternating displacements. These platforms do not have a uniform displacement.  The platform oscillates over a central fulcrum, intended to simulate how humans walk.

Literature comparing the effects of vibration direction on bone is limited; therefore the overall effect the direction of vibration has on bone density or whether either direction is more beneficial is unclear. (1)

Frequency and Magnitude of the Vibration

• A WBV platform provides several different vibration frequency and magnitude options.
• Frequencies below 20 HZ interfere with the vibration frequencies of our internal organs. (1)
• Above 70 Hz muscle damage has been shown to occur. (1)
• Studies that demonstrate improvements in muscle strength and size using WBV have employed frequencies of 25 to 45 Hz (1, 3,11-19).
• Frequencies between 20 and 70 Hz are the recommended safety range.

Guidelines on Whole Body Vibration Still Lacking

As a result of the large number of vibration factor interactions and whole body vibration therapy contraindications, standardized Whole Body Vibration guidelines for the maintenance or improvement of BMD among older adults or those with physical or neurological impairments have not yet been established.

For individuals who cannot weight bear or stand independently, Whole Body Vibration can be modified or used in conjunction with other rehabilitation apparatus, such as a passive standing frame or a body-weight supported harness. (1)

Whole Body Vibration Therapy Contraindications

Registered equipment manufacturers have identified a number of whole body vibration therapy contraindications and suggest that individuals who have one of the following conditions should not partake in WBV training:

• Kidney or bladder stones.
• Arrhythmia.
• Pregnancy.
• Epilepsy.
• Seizures.
• Cancer.
• A pacemaker.
• Untreated orthostatic hypotension.
• Recent implants (joint/corneal/cochlear, etc.).
• Recent surgery.
• Recently placed intrauterine devices or pins.
• Acute thrombosis or hernia, acute rheumatoid arthritis.
• Serious cardiovascular disease.
• Severe diabetes.
• Migraines (6-8).

Among individuals with spinal cord injury (SCI), several adverse events were reported including pain, pressure sores on the feet, autonomic dysreflexia, and dizziness, which were largely attributed to the passive standing portion of the intervention.

Researchers at Lyndhurst Centre caution that Whole Body Vibration may elicit inner ear troubles, dizziness, headache, lower-limb spasticity, fracture (especially among those with severe osteoporosis), and/or hardware loosening (plates or screws as a result of surgery).(20)

Larger clinical trials are required to confirm the utility of Whole Body Vibration for improving bone mass among children and young adults.

The literature looking at the effects of Whole Body Vibration on bone health among older adults and postmenopausal women is somewhat inconclusive.

A recent systematic review and meta-analysis on the effects of Whole Body Vibration on BMD in postmenopausal women concluded that Whole Body Vibration slows down bone loss at the hip (21) the benefits are similar to walking.

References

1. Totosy de Zepetnek JO et al. Whole-body vibration as potential intervention for people with low bone mineral density and osteoporosis: A review JRRD Vol 46, No. 4 2009 pg 529-542
2. De Gail P, Lance JW, Neilson PD. Differential effects on tonic and phasic reflex mechanisms produced by vibration of muscles in man. J Neurol Neurosurg Psychiatry. 1966; 29(1): 1–11
3. Bosco C, Iacovelli M, Tsarpela O, Cardinale M, Bonifazi M, Tihanyi J, Viru M, De Lorenzo A, Viru A. Hormonal responses to whole-body vibration in men. Eur J Appl Physiol. 2000; 81(6):449–54.
4. Kvorning T, Bagger M, Caserotti P, Madsen K. Effects of vibration and resistance training on neuromuscular and hormonal measures. Eur J Appl Physiol. 2006;96(5):615–25.
5. Rubin C, Pope M, Fritton JC, Magnusson M, Hansson T, McLeod K. Transmissibility of 15-hertz to 35-hertz vibrations to the human hip and lumbar spine: Determining the physiologic feasibility of delivering low-level anabolic mechanical stimuli to skeletal regions at greatest risk of fracture because of osteoporosis. Spine. 2003; 28(23): 2621–27.
6. Whole Body Advanced Vibration Exercise [Internet]. Windsor (Canada): WAVE Manufacturing Inc; c2009 [updated 2009; cited 2008 Apr 1]. Available from: http://www.wavexercise.com/.
7. VibraFlex [Internet]. Naples (FL): Orthometrix, Inc; c2006–9 [updated 2009 Jun 1; cited 2009 Jan 15]. Avail- able from: http://www.vibraflex.com/.
8. TurboSonic      [Internet].      Hood River (OR): TurboSonic USA; c2007–8 [updated 2008; cited 2009 Jan 15]. Avail- able from: http://www.turbosonicusa.com/.
9. Galileo:      Whole      Body      Vibration      [Internet].      Hornsby Heights (Australia): Novotec Medical; c2008 [updated 2008 Mar 11; cited 2009 Jan 17]. Available from: http://www.galileowholebodyvibration.com.au/.
10. Juvent [Internet]. Somerset (NJ): Juvent Medical, Inc; c2007 [updated 2007; cited 2009 Jan 17]. Available from: http://www.juvent.com/.
11. Delecluse C, Roelants M, Verschueren S. Strength increase after whole-body vibration compared with resistance train- ing. Med Sci Sports Exerc. 2003;35(6):1033–41.
12. Bosco C, Cardinale M, Tsarpela O. Influence of vibration on mechanical power and electromyogram activity in human arm flexor muscles and whole body vibration therapy contraindications. Eur J Appl Physiol Occup Physiol. 1999;79(4):306–11.
13. Bosco C, Colli R, Introini E, Cardinale M, Tsarpela O, Madella A, Tihanyi J, Viru A. Adaptive responses of human skeletal muscle to vibration exposure and whole body vibration therapy contraindications. Clin Phys- iol. 1999;19(2):183–87.
14. Kerschan-Schindl K, Grampp S, Henk C, Resch H, Preis- inger E, Fialka-Moser V, Imhof H. Whole-body vibration exercise leads to alterations in muscle blood volume. Clin Physiol. 2001;21(3):377–82.
15. Abercromby AF, Amonette WE, Layne CS, McFarlin BK, Hinman MR, Paloski WH. Variation in neuromuscular responses during acute whole-body vibration exercise. Med Sci Sports Exerc. 2007;39(9):1642–50.
16. Torvinen S, Kannus P, Sievänen H, Järvinen TA, Pasanen M, Kontulainen S, Järvinen TL, Järvinen M, Oja P, Vuori I. Effect of four-month vertical whole body vibration on per- formance and balance. Med Sci Sports Exerc. 2002; 34(9):1523–28.
17. Torvinen S, Kannus P, Sievänen H, Järvinen TA, Pasanen M, Kontulainen S, Nenonen A, Järvinen TL, Paakkala T, Järvinen M, Vuori I. Effect of 8-month vertical whole body vibration on bone, muscle performance, and body balance: A randomized controlled study. J Bone Miner Res. 2003;18(5):876–84.
18. Roelants M, Delecluse C, Goris M, Verschueren S. Effects of 24 weeks of whole body vibration training on body composition and muscle strength in untrained females. Int J Sports Med. 2004;25(1):1–5.
19. Torvinen S, Kannu P, Sievänen H, Järvinen TA, Pasanen M, Kontulainen S, Järvinen TL, Järvinen M, Oja P, Vuori I. Effect of a vibration exposure on muscular performance and body balance and whole body vibration therapy contraindications. Randomized cross-over study. Clin Physiol Funct Imaging. 2002;22(2):145–52.
20. Craven BC. Effectiveness of vibration and standing versus standing alone for the treatment of osteoporosis for people with spinal cord injury. http://clinicaltrials.gov/, NCT00150683; 2001.
21. Slatkovska L, Alibhai SMH, Beyene J, Cheung AM, edi- tors. The efficacy of whole-body vibration in reducing bone loss in postmenopausal women: A meta-analysis. Proceedings of the ASBMR 30th Annual Meeting; 2008 Sep 12–16; Montreal, Canada. Washington (DC): ASBMR.

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